Provider Demographics
NPI:1801202536
Name:CARE ADVANTAGE INC
Entity Type:Organization
Organization Name:CARE ADVANTAGE INC
Other - Org Name:CARE ADVANTAGE FAIRFAX
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-323-9464
Mailing Address - Street 1:10041 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4815
Mailing Address - Country:US
Mailing Address - Phone:804-323-9464
Mailing Address - Fax:804-330-3156
Practice Address - Street 1:10680 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3810
Practice Address - Country:US
Practice Address - Phone:703-436-4767
Practice Address - Fax:703-272-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VANOT ISSUED YETMedicaid